The Importance of Treatment for Borderline Personality Disorder

Treatment, Research, Remission, and Recovery

Women in a group therapy session
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If you or someone you love has borderline personality disorder (BPD), you might wonder if there's a cure. In a nutshell, BPD is absolutely treatable and remission of your symptoms is not only possible, but it's also extremely likely. Unfortunately, there's a lot of misinformation out there and it can take some time to understand the terms that doctors use, as well as what the research really says about treating BPD.

Understanding the Terms

Though mental health specialists rarely use the word "cured," many use the terms remission and recovery. Remission is defined as getting to a place where you find significant relief from your symptoms, so much so that you no longer meet the criteria for a diagnosis of BPD. Recovery is a broader term and not as well-defined, but along with symptom relief, it involves functioning well in all aspects of your life for an extended period of time, such as holding down a job that you find fulfilling and having meaningful close relationships with others.

The Treatment Myth

One very common myth is that borderline personality disorder can't be treated. Fortunately, this is an old-fashioned notion that's not based on current research. In the past, experts did believe that BPD didn't respond to treatment and that it was a lifelong condition that changed little over the course of a person's life. However, there's now evidence showing that a large number of people with BPD who receive treatment eventually achieve remission from their symptoms. This sometimes happens even without treatment.

Not everyone experiences such dramatic symptom reduction, at least not for a while. Many people who undergo treatment for borderline personality disorder continue to have symptoms, but find them to be much more tolerable, and report that they are able to function far better in their lives. In this way, BPD is similar, in some ways, to diabetes. With treatment, the disease doesn't go away, but with careful attention, the symptoms can be managed very well on a potentially long-term basis. You may hear your therapist talk about " long-term control" and this is what he or she means.

What the Research Says

Multiple studies have consistently shown that most people achieve remission from their BPD symptoms eventually. Remember, remission is defined as no longer meeting the criteria for a BPD diagnosis. In fact, one study that followed up with 290 BPD patients every two years for up to 16 years found that remission periods of two to eight years are very common. After 16 years, 99 percent of the BPD patients involved in the study had achieved a two-year remission while 78 percent experienced an eight-year remission.

Further statistics from the same study revealed that after two years, 35 percent had experienced an extended remission period, defined as two years or more, and after 10 years, 91 percent had. The researchers also found that recurrences of BPD symptoms to the point where patients met the diagnostic criteria for BPD once again were relatively uncommon and ranged from 36 percent of patients after a two-year remission to only 10 percent of patients after a remission period of eight years. This indicates that the longer your remission period, the less likely it is that you'll have a recurrence of a BPD diagnosis.

Types of Treatment

In the past few decades, a number of new psychotherapeutic treatments for BPD have been developed that have been shown to be extremely effective in reducing the symptoms of BPD. There's no way to know how any one individual with borderline personality disorder will respond to the various treatment options that are available, but these treatments for BPD are remarkably effective and may reduce or stop many of your symptoms. And even if you don't fully recover from BPD, treatment is greatly helpful in improving your ability to function and your overall quality of life.

Psychotherapy

The number one treatment for borderline personality disorder includes specialized psychotherapies, also known as talk therapy, such as:

  • Dialectical behavior therapy (DBT)
  • Schema-focused therapy
  • Mentalization-based therapy
  • Transference-focused therapy
  • Cognitive behavioral therapy (CBT)
  • Good psychiatric management

All of these therapies seem to be equally effective and have similar processes. For instance, they all focus on your current relationships and how you're functioning right now, as well as teach you skills like how to regulate your emotions, how to stop acting impulsively, and how to be mindful of your own and others' feelings. Different types of therapy may only be available in certain areas of the country, so you can choose a type based on your own preference and what's offered near you.

Medication

Medications can also be helpful in treating some of the symptoms of BPD. Some commonly prescribed medications for BPD symptoms include:

  • Antidepressants
  • Antipsychotics
  • Antianxiety medications
  • Mood stabilizers

The Role of Co-Occurring Conditions

One study found that 85 percent of people with BPD also have at least one other mental health disorder as well, usually mood disorders such as major depression or bipolar disorder, anxiety disorders, substance use disorders, and/or eating disorders. People who are diagnosed with BPD often meet the criteria for other personality disorders as well. The average number of co-occurring conditions in BPD is three.

These co-occurring conditions, or comorbidities, make treatment a bit more complex and sometimes result in a delayed or missed diagnosis of BPD since many of the symptoms can be similar. Often, one of the other disorders is diagnosed before BPD. However, considering that the majority of people with BPD have these comorbidities, treatment is targeted to which disorder(s) to focus on for the best success.

This is also where medications can play a part in your treatment, depending on your additional diagnoses. For instance, if you also have a major depressive disorder (MDD), a common comorbidity with BPD, you may need an antidepressant to help reduce your symptoms of sadness, emptiness, worthlessness, and guilt, all of which occur in both MDD and BPD.

What to Do If You're Diagnosed With BPD

If you think you may have BPD or you've been diagnosed with BPD, keep these points in mind:

  • Don't panic. As previously discussed, there is plenty of research that proves that treatment makes a tremendous difference in reducing BPD symptoms. With treatment, you can expect to have a better quality of life and it's likely that you'll eventually achieve a sustained period of remission. Plus studies show that the earlier in life you get treatment, the easier it may be to achieve remission or even recovery.
  • Make sure you see a mental health specialist who has experience diagnosing BPD. Misdiagnosis of borderline personality disorder appears to be common because of the overlap between symptoms of mental health conditions discussed previously and the fact that most BPD patients have at least one other mental health disorder diagnosis. Because of this, it's important that you see a mental health professional who is experienced in BPD diagnostics.
  • Get the right therapist for you. Finding a good therapist is essential, both to determine if you truly have BPD, and to help you manage the symptoms if you do. You may need to interview a few therapists before you find the right one with whom you feel safe and comfortable. Your therapist can help you manage your disorder over the long term, until such a time that you may be ready to discontinue therapy.
  • Educate yourself. Take the time to learn about your condition and be your own advocate in your care. Should you have any other co-occurring mental health disorders along with BPD, your improvement and remission will thus require learning about and managing these different aspects of your condition as well.
  • Apply some new skills. In addition to learning all that you can about your disorder(s), learning some self-help strategies can be beneficial. Many of the coping skills used to deal with BPD are tools that can help anyone, and therefore they may help you whether or not you continue to fit the criteria for BPD in the future.
  • Involve your family. When we discuss the treatments for BPD we often talk about individuals, but a diagnosis of BPD in a family member affects all the members of the family and creates unique challenges. In addition to a traditional treatment plan, family therapy for BPD can help not only you, the person living with the disorder but your whole family as well.
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